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Sunday, December 26, 2010

Sunday Op Ed Piece - It's Time for Change, But Can We Do It?

Most Americans believe that the United States has the greatest healthcare system in the world, rightfully so. As the country moves into a new decade, many questions remain unanswered as to how we create an affordable healthcare delivery system, while equitably compensating physicians for their services. The notion that Obamacare is a socialist program is laughable. The public has not been privy to all of the back door deals that were negotiated with Big Pharma and the Insurance Industry so a half-assed healthcare reform bill could be passed. The statistical fact that 50% of all personal bankruptcies are attributed to catastrophic healthcare should be cause for concern that there is something fundamentally wrong with the entire system. When patients, doctors, and hospitals are at the mercy of an unaccountable insurance industry, that can deny coverage, fix and manipulate pricing, deny claims, and intimidate and scare patients, it's time for the Federal Government to repeal the McCarron-Ferguson Act of 1945.

TSB can hear the moans and groans from the Spine Nation. WTF? How crazy is this person, asking us to rise up and start a campaign for the Federal Government to finally challenge this legislation in a court of law. In order for those of you that don't believe that this is an issue of life and death, one needs to understand how this Act effects our industry. The average person needs to understand the machinations of how McCarron-Ferguson works to keep the government off the backs of the insurance industry. Of course, the free-marketeers will react in typical knee-jerk style without looking at the view from thirty thousand feet. Historically, McCarron and Ferguson worked to invalidate the U.S. vs. South Eastern Underwriters Association Supreme Court decision and established ground rules for decades of highway robbery by our friendly insurance industry. Essentially, the bill is a heist perpetrated upon the American people by elected officials in concert with the insurance industry.

McCarron-Ferguson was originally written to maintain authority by the states over the insurance industry, but, it also included a provision that the Sherman Act would apply if and when state laws were inadequate. Basically, it was intended to be a temporary law set to expire in 1947. As with any bill, it can be rewritten. A new clause emerged from conference that stated that after January 1, 1948, the Sherman, Clayton, and FTC acts "shall be applicable to the business insurance to the extent that such business is not regulated by the State Law. Instead of being a temporary Act, allowing the Sherman Act to be applied when state laws proved inadequate, the law became permanent excluding the application of the Sherman and Clayton Acts. Therefore, the insurance industry was given a license to steal.

How absurd is it that physicians are not allow to collaborate and determine structural pricing, or they will be thrown into jail, yet, the big bad insurance industry colludes by sharing and setting reimbursements by manipulating the market? Ever hear of INGENIX? It gets crazier when in 1980 an amendment to the Federal Trade Act was passed making it illegal for the Federal government to investigate the insurance industry? A LEGAL CHALLENGE to ending the Anti-Trust Exemption for the Insurance Industry should be a mandate from all people. Isn't it absurd that Senator Ben Nelson has received over $1,259,000 in campaign contributions from the insurance industry and the Democratic Party caved in and gave Nelson's Nebraska $100 million and allowed Nebraska to have its Medicaid payments subsidized by other states? Isn't it time that an anti-competitve law passed over sixty years ago by mistake, be repealed?

Our industry loves to chase a wagging tail. How absurd is it for a physician to unequivocally blame sales people for driving up the cost of healthcare? How absurd is it for a CEO to pontificate at an Analysts' call about how insurance companies are denying coverage to patients, which in turn affect a companies ability to achieve its fiscal guidance? If anything, we have learned that by dividing, one can conquer, or at least keep everyone busy arguing with one another. A mandate to citizens that they must all be covered is not a solution to the problem. If anything, it is another empty promise, another stop gap measure. Of course, many bloggers will attack the point of this editorial, claiming that TSB is a socialist, that TSB desires to impede free-markets. But unless one truly exposes oneself to the realities of the system, how can one understand the issues at hand? How can we be competitive, if our own elected officials game the system? How will you make the correct choice in 2012 at the ballot box? The reason TSB infuses political issues into our posts is because everything we do in life is influenced and determined by politics.

So in closing, if NASS, AAOS, AANS, CNS, AMA, etc, etc, etc, really want to make a difference, don't spend your money on lobbying bullshit issues that just keep greasing the wheel, take a real position on an issue that is effecting not only your livelihood but your ability to deliver the best healthcare in the world. TSB wants to know, are you part of the problem, or do you want to be part of the solution?

29 comments:

I love these posts. They are the proverbial light that sends the cockroaches in our industry scurrying for cover. Unfortunately, this cover takes the form of comments that spew FOX News talking points and, ultimately, sully this wonderful blog.

Those crazy tea bagging, randian, fox watching, gun toting, religious, hicks are going to have "knee jerk" reactions again! Silly majority, don't they know we are smarter than them and we should just make their decisions for them?

Let's just hope they don't realize that there is ABSOLUTELY no constitutional authority for us to do any of this!

Completely agree that the insurance industry is utterly out of control. Disagree that this is the best health care system in the world. Not by a long shot. As long as economic considerations are the main if not only driver for every decision affecting the health of the patient, whether taken by the insurance company, the clinician, the hospital, or the industry representative, it never will be either. Long live the controlled free market systems in Germany, Switzerland, The Netherlands, Scandinavia and some other advanced nations.

GS, JPMC, MS, Shittybank, geniuses all providing social utility, I mean criminals at best. Where's that idiot Rick "the dick" Scumtelli screaming about the socialism for these Nazi's like he blamed homeowners for being irresponsible while brokers and mortgage bankers rigged the system.

Storn the insurance industry and vote every blood sucking Senator our of Office. It's time. Ben Nelson is a mummy embalmed in formaldehyde Obama cut a deal with him to get his vote on what the POTUS calls healthcare reform, LOL.

MM, love the blog overall... I have recently been one of the more conservative voices in the comments. I actually agree with your idea, but I think you we need to take the idea further, and remove the government from healthcare and insurance to a larger degree. History has born out time and again that advances have not come from any government decree, but by individual initiative.

Place the responsibility on the individual, the stockholder, and the consumer, and this stuff will all go away.

Your blog has not only been a nice forum for industry information, political dialogue, mixed with some humor, but it has really opened my eyes to just how utopian and immature some points of view are. Progressives are dangerous, and ignorant to history.

Sad times folks.

Let's try to find a cool topic for some quality clinical discourse...maybe nucleus replacement technologies, or new approaches for MISS...

Idiot, a political rant? How long do we let the insurance industry hold everyone hostage? Do you even understand how this effects everyone including the industry? Must be someone who has had there feelings hurt at Centinel.

What is the matter with those Centinel guys first they get beat up by TSB on this blog and now they await a good old fashioned ASS KICKING from Mike O'Neal, you live by the sword, you die by the sword.

Quiz time! First to name something that government has run well or made cheaper wins!

Insurance companies suck, and private industry ( banks) should not be bailed out, when you're trying to fix something, let me give you a hint...government is NEVER the answer.

Compassionate people have been suckered into being progressives. Someone is being disenfranchised so government needs to step in, get more control, and help them. Our country was started to get away from government control, don't give it back willingly.

I disagree with the "statistical fact that 50% of all personal bankruptcies are attributed to catastrophic healthcare". Not that healthcare costs didn't attribute to the bankruptcies, but that it will change with universal healthcare. The majority of people have insurance they pay for and all of those people with insurance that declared bankruptcy, would still declare under Obamacare (only sooner since premiums and OOP costs will be higher).

I agree that insurance needs a bit of an overhaul with simple legislation that prevents them from doing certain things and they certainly need to be accountable. But the answer is not to give all of the power to the federal government with no accountability. If you read the bill (I did), the Secty of Health and Human Services (Kathleen Sebelius) gets to make all of the important decisions, after the bill passed, and none of those decision are subject to administrative or judicial review. It says those exact words in the bill, many times and it means that whatever she says, goes, and no one can challenge it in a court of law.

As another post stated, government cannot compete in industry, but they should protect consumers from abusive private industry behaviour.

We need to be able to buy insurance across state lines (competition), make insurance policies portable so people are not handcuffed to a job (eliminates the pre-existing exclusion) and have more restrictions on benefit loopholes and "amendments" to benefit packages that aren't published. I personally think a policy should cover any service the patient and physician agree to. It doesn't make sense to me to have services that are excluded since you don't know what kind of illness you might have after you are covered.

A lot needs to be done, but having an inherently bloated, inefficient, politically motivated government entity running healthcare is a bad mistake. We all know that the only way they can cut costs is to trim the budget, which will lead to a reduction of available services. They will never have the capability to lower costs based on clinical improvements or system efficiencies. That is the only known fact in this argument.

For the record, TSB never implied nor inferred that government should run healthcare. The post was meant to provide bloggers with an understanding of why MF'45 needs to be repealed, whether in a court of law or by the Congress. Entrusting the State Insurance and Banking Commissions' to provide insurance oversight is a complete joke. It's like giving an arsonist a book of matches to play with. Government will always be involved in the management of Medicare and Medicaid, even if they have mismanaged every cent that has been paid or allocated into it. As disorganized and disinterested as most voters are , the only way to change the system is to vote the "dead wood" out, aka the usual suspects, Nelson, McConnell, Reid, Grassley, Lautenberg, Kyl, Lieberman, Leahy etc.... our industry has plenty of those. These individuals and others in the House are only interested in perpetuating their existence as DC power brokers while selling us out to special interests. As an FYI, don't get too caught up in the bill, its what's not in the bill that has been negotiated behind close doors that really matters. TSB realizes that many readers don't focus on the issue at hand. You can't rip the foundation out until you start at the top if you want to rebuild a house.

I guess the word "reform" is an exponentially relative term these days...

@ 10:02 - you CAN buy insurance across state lines, but good luck being "in-network" as physician groups and providers strike the most lucrative, and therefor most beneficial, deals with insurers that can deliver the most "customers". In other words, coverage is not universal under the current model, save for out-of-network plans, at which point you would still be paying big $$$.

@7:17PM - Hearin' Ya! Freedom is very hard work. Thus, every culture having burrowed out from under a monarch into some manner of representative self-governance is working on crawling BACK UNDER an ersatz monarch-form seeking 'security'.